Abstract P2076: β-hydroxybutyrate Administered At Reperfusion Alleviates Myocardial Ischemia-reperfusion Injury By Enhancing Autophagy And Mitochondrial Homeostasis

Abstract

Introduction: ST-elevation myocardial infarction (STEMI) is the leading cause of heart failure. Ischemia/reperfusion (I/R) injury after revascularization contributes ~50% of infarct size, which we don’t have a clinical therapy. β-hydroxybutyrate (β-OHB) is a metabolite that increases during stress. In addition to providing energy, it serves as a signaling molecule (such as histone deacetylase inhibitor) to regulate many protective processes. Increasing the β-OHB level before I/R is cardiac protective. However, it has not been tested when administered at reperfusion. Hypothesis: The physiological concentration of β-OHB administered at the time of reperfusion reduces I/R injury by enhancing autophagy and mitochondrial homeostasis. Methods: C57BL6 wild-type mice were randomized into 2 groups and subjected to I/R surgery (I: 45 mins; R: 24 hrs). At reperfusion, normal saline or 10 mmol/kg of β-OHB (4-6 mM blood level) was given intraperitoneally. Echo was used to evaluate cardiac functions. We measured Infarct size, autophagic flux, and mitochondrial DNA levels in the heart. CAG-RFP-GFP-LC3 (RFLC3) mice were used to detect autophagic flux. Neonatal rat ventricular myocytes (NRVMs) were subjected to simulated I/R to test the effect of β-OHB in vitro . Small interfering RNA of ATG7 gene was used to assess the role of autophagy. Seahorse assay was performed to evaluate mitochondrial function after I/R. Results: β-OHB gave at reperfusion reduced infarct size by 50% (N=15 in control and N=11 in β-OHB group), and preserved systolic function in mice. In the border zone, the LC3II and the mtDNA level increased, and β-OHB increased autophagic flux in RFLC3 mice (N=5). In NRVMs subjected to I/R, β-OHB increased histone acetylation, cell viability, and maintained mitochondrial homeostasis (mitochondrial mass, membrane potential), and reduced ROS generation (N=4-6). Seahorse assay showed β-OHB enhanced ATP production after I/R. ATG7 knockdown blocked the protective effect of β-OHB in NRVMs. Conclusions: β-OHB administered at reperfusion reduces infarct size by increasing autophagic flux and maintaining mitochondrial homeostasis. Since β-OHB has been used in heart failure patients safely, it is a viable therapeutics to reduce infarct size in STEMI patients.